In this interview, Ronald Sherman, DPM, MBA, and Christopher Abularrage, MD, address the steps they take to treat infected diabetic foot wounds of varying degrees, including those with osteomyelitis.

Laura Swoboda, DNP, APNP, FNP-C, FNP-BC, CWOCN-AP, WOCNF

The small bright red cobblestone texture of healthy granulation tissue is just that: a granule of new collagen and the new growth of capillaries. Hypergranulation is the excessive growth of granulation tissue, a symptom of a dysfunctional wound environment. Providers can identify hypergranulation by its appearance. As opposed to the bright, bubbly red appearance of healthy granulation tissue, unhealthy granulation, and hypergranulation tissue can present as large lobes of red tissue, and the coloration can vary between bright red and darker shades. These lobes will typically sit above skin level.

Recent literature has established that there is much for the medical community to learn about highly pigmented skin, specifically in the realm of wound healing and even more so in diabetic foot ulcers (DFUs). Most distressing is the higher prevalence of amputation and mortality among patients with skin of color and DFUs as opposed to their Caucasian cohorts. In fact, a 2022 study found that patients identifying as Black were approximately 4% more likely to experience above-ankle amputation or death.

Skin is considered the body's largest organ, and any damage can often lead to scarring. Although the pathology and physiology of what leads to scarring are not entirely understood, some details are concrete, including the series of processes that occur after the skin is damaged. These processes will be discussed in detail below, as well as the different types of scars. The appearance of these scars, as a result of these processes, may also present differently on various skin tones and types.